We need a global treaty on health research for the poor

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It's time to move from debate to action with new mechanisms for funding research into diseases faced by developing countries.

In the current financial and political climate, it is brave — some might say foolhardy — to propose a binding international treaty on the funding and coordination of research into health problems facing the developing world.

Nevertheless this is what the World Health Assembly (WHA), the body responsible for the policies of the WHO, is being asked to consider at its annual meeting in Geneva next month (21–26 May).

The proposal comes from the WHO's Consultative Expert Working Group on Research and Development (CEWG), which has spent the past year analysing various ways of enhancing research and development (R&D) of treatments for diseases prevalent in developing countries.

Its report, released two weeks ago (5 April), lists measures that could bridge the continuing gap between the potential that science offers for creating such treatments, and the failure of the market to provide adequate incentives to make them affordable.

Top priority, it says, is starting negotiations on a binding convention on R&D. A central idea is that governments should commit to spending 0.01 per cent of GDP on R&D that is relevant to the needs of developing countries.

It also examines possibilities for new sources of sustainable funding, in particular through taxation — for example on air travel, alcohol or financial transactions — according to each country's preference.

An uncomfortable void

Both run counter to the prevailing political winds. This is a time when foreign aid budgets are being cut in many parts of the world —Canada is the latest government to do so— due to spending constraints and in the belief that the market should be treated as the main driver of development.

But the proposal deserves support. Disease is not only an endemic problem with social implications in developing countries; it is also a financial burden, depriving them of the healthy workforce needed to reach anything like their full potential.

There are therefore both moral and economic grounds for finding more effective ways to combat health problems in these countries.

The problem of the gap between what science can offer and what it has delivered was first identified in the 1990s. The best way of addressing it has been hotly debated over the past decade, for example at the bi-annual Global Forum for Health Research, the latest of which, Forum 2012, takes place in Cape Town next week (24-26 April).

A succession of committees and working groups has looked at a range of proposals to address the fact that selling drugs to the poor reaps fewer profits for the pharmaceutical industry than R&D for diseases of the rich.

Filling the gap

The proposals aim to increase access to medications by breaking the link between the costs of research and the price of treatments. One possibility is to introduce prizes for innovative research as an alternative to lucrative — but potentially restrictive — patents.

In its report the CEWG recommends promoting "open knowledge innovation" as a priority. The idea is that new medical innovations are developed most effectively, and at the lowest cost, if research results are shared freely without the restrictions of registering them as intellectual property.

Other ideas that meet the CEWG's feasibility criteria range from providing direct grants to small and medium-sized companies, to extending the practice of patent pools, in which patent-holding drug companies agree to forgo their patent rights in selected countries to allow local companies to make medicines generically at mutually-agreed licence fees.

But putting all these ideas into practice needs coordination. And this is more likely to be effective if it is linked to a funding mechanism — which is where the idea of a new treaty comes in.

Waiting for endorsement

Unsurprisingly, the idea of such a convention has been warmly welcomed by non-governmental organisations involved in health issues. A statement from the Switzerland-based think tank the South Centre, for example, describes it as potentially "the most important achievement of the WHO in the area of medicines since its creation". [2]

Equally unsurprising is its lukewarm reception from the pharmaceutical industry. Falling short of open opposition, a spokesperson for the International Federation of Pharmaceutical Manufacturers and Associations argues that "there is not a one-size-fits-all approach to stimulating R&D" into diseases affecting developing countries.

The real test will come at the political level. Even if the WHA decides to endorse it, implementation of a binding convention — particularly if it included funding commitments — is likely to be a lengthy and challenging task.

But that is no excuse for failing to move from debate to action. Even with the intervention of bodies such as the Bill & Melinda Gates Foundation, the gap between needs and solutions in medical health research for developing countries remains as wide as it was ten years ago. How much longer will we have to wait until a serious government-backed attempt is made to bridge it?